Home Care Is No Longer the Future - It's the Foundation of Long-Term Care

by Jamie Daugherty, Executive Director

For years, policymakers, providers, and consumers have talked about the future of healthcare being in the home. Today, that future has arrived.

The recently released 2026 Medicaid Home Care Chartbook, developed by the Research Institute for Home Care in partnership with the Alliance for Care at Home, highlights a reality that those of us in Oregon have recognized for decades: home-based care is increasingly the backbone of our long-term care system.

As our population ages and healthcare costs continue to rise, more Americans are choosing—and expecting—to receive care in their homes and communities rather than in institutional settings. Medicaid, the nation's largest payer of long-term services and supports, has steadily shifted resources toward home and community-based services (HCBS), reflecting both consumer preference and sound fiscal policy.

Oregon has long been recognized as a national leader in this movement. Our state was among the first to embrace alternatives to institutional care, investing in systems that allow older adults and individuals with disabilities to remain in their homes whenever possible. The results have improved quality of life for countless Oregonians while demonstrating that care delivered in the home can be both effective and cost-efficient.

Yet the Chartbook also serves as a reminder that significant challenges remain.

Demand Continues to Grow

The demographic trends driving home-based care are impossible to ignore. Americans are living longer, managing more chronic conditions, and increasingly seeking care in familiar surroundings. These trends are accelerating demand across the entire continuum of home-based services, including personal care, home health, hospice, and palliative care.

For providers, this demand presents both opportunity and responsibility. Home-based care organizations are being asked to care for more individuals with increasingly complex needs, often in areas where healthcare resources are already stretched thin.

Workforce Challenges Threaten Access

Perhaps the most significant challenge facing the home care sector is workforce availability.

Across Oregon, providers continue to struggle with recruitment and retention of caregivers, nurses, therapists, and other essential staff. Rural communities face particular difficulties, where geography, travel distances, and limited labor pools can make staffing even more challenging.

The reality is simple: access to care depends on access to caregivers.

Without a stable and adequately supported workforce, even the strongest care delivery models cannot meet growing demand. Policymakers must recognize that investments in workforce development, training, reimbursement, and retention are investments in access to care itself.

Quality Measurement Is Becoming More Important

Another theme emerging from national discussions is the growing emphasis on quality measurement and accountability within Medicaid HCBS programs.

Recent federal efforts to establish a standardized HCBS Quality Measure Set signal an increasing focus on demonstrating outcomes and program performance. While providers have always been committed to delivering high-quality care, future policy decisions will likely rely more heavily on measurable data and outcomes.

This shift presents an opportunity for providers to showcase the value of home-based care while also preparing for new reporting and quality expectations.

Oregon's Opportunity

Oregon has a strong foundation on which to build. Our history of supporting home and community-based services positions us well for the future. However, maintaining that leadership will require continued collaboration among providers, policymakers, advocates, and payers.

As demand grows, we must continue advocating for policies that strengthen the workforce, support sustainable reimbursement, expand access in rural communities, and recognize the essential role home-based care plays throughout the healthcare continuum.

The newly released Medicaid Home Care Chartbook provides valuable insight into where the nation stands today. More importantly, it reinforces what providers across Oregon already know: home care is no longer simply an alternative to institutional care.

It is the foundation of long-term care in America.

As we look ahead, ensuring that foundation remains strong will be one of the most important healthcare challenges—and opportunities—of our time.

Resource Spotlight: The Research Institute for Home Care and the Alliance for Care at Home recently released the 2026 Medicaid Home Care Chartbook, providing state-level and national data on Medicaid home-based care utilization, spending, and trends. OAHC encourages members to review the report and consider how these trends may shape future policy and reimbursement discussions.